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We must plug the gap in care for service veterans

I recently had the honour of speaking at the national conference ‘Veterans’ Mental Health – the Road Ahead’, on the work NHS England is doing to help improve care and treatment in this area.

What struck me most about being there was the overwhelming commitment of all those present to help ensure treatment and support for veterans and their families with mental health needs is the very best it can be.

While evidence shows the majority of veterans who leave the armed forces go on to enjoy civilian life without significant problems, there are a minority who experience mental and physical difficulties as a result of their military service.

It was this ‘minority’ that brought together senior leaders from the political arena, the NHS, academia, the third sector and Metropolitan police to discuss and share evidence and research to help ensure our armed forces veterans receive the support they so rightly deserve and are entitled to.

For me, the biggest priority area is ensuring the right pathways of support are in place and this means starting from when armed forces personnel are nearing the end of their service. It is at this point we need to identify what onward support they will require from the NHS so the right care and treatment is in place ready for them. This is vital in facilitating a smooth transition to civilian life, alongside which we must consider the wider health needs of their families.

This very much sits at a community level with the appropriate services being readily available when needed, highlighting the importance of clinical commissioning groups (CCGs) reflecting this in their planning.

Although NHS England currently commission mental health services for veterans, CCGs are responsible for the wider commissioning of mental health services in their area and as part of this, must understand and consider the health needs of veterans and their families. This can’t be undertaken in isolation though and requires close working with local authorities and third sector organisations to ensure associated health needs are reflected in joint strategic needs assessments (JSNAs).

This is something I urge local authorities and CCGs to change in order to ensure local commissioning plans are considerate of this and the right treatment and support are available via a range of service options.

In moving towards this ambition though, it is important that we better understand when and how veterans are first presenting and how they are moving between different services. This requires us to work closer together and change the current mind set of competitive service provision. We can then start to offer a range of access points that provide consistent and timely wrap around support. This is particularly important for those veterans with complex needs, such as Post Traumatic Stress Disorder and alcohol and substance misuse.

Never has there been such a focus on mental health – we are starting to see people open up more about their experiences and seek help, however, there is still more that we can do to improve access and service provision. This is reiterated in the recently published Five Year Forward View for Mental Health for the NHS in England, which sets out a strategic approach to improving mental health outcomes across the health and care system, in partnership with the health arm’s length bodies.

To make sure we are commissioning wisely with veterans and families at the heart of our decisions, we need to move forward on our collective ambitions that came across so strongly at the ‘Veterans’ Mental Health – the Road Ahead’ conference. Every commissioning decision we make has the potential to affect a veteran in some way and I ask you to keep this front of mind to ensure we are best delivering the health commitments of the Armed Forces Covenant so none of them are disadvantaged.

NHS England would like to hear about your experiences and views of mental health services for veterans and explore the reasons why some people have not sought or received support and treatment. Find out more and complete the survey. The deadline for responding is 31 March 2016. Findings from the survey will help to ensure that future mental health services for veterans best meet the needs of those who have served in the armed forces.

As such she oversees three areas of direct commissioning services across England for healthcare for serving personnel and their families and veterans’ mental health and prosthetics; sexual assault referral centres (SARCs); health and justice healthcare services in prisons, secure children’s homes and training centres, immigration removal centres; and the development of the national liaison and diversion programme and street triage.

This national role is to assure quality, consistent and sustained services with a strong focus on health inequalities and outcomes for patients and their families.

Kate has developed and led the national partnership agreement between the Ministry of Defence for Armed Forces commissioning, Ministry of Justice for prisons and children and secure settings and the Home Office for immigration removal centres.

Previously, Kate was the Executive Lead for Prison, Detainee and SARCs Healthcare Commissioning for East Midlands and led the healthcare commissioning for prison and offender health.

From December 1995 to May 2009, Kate was the Strategic Director of the award winning Nottinghamshire County Drug and Alcohol Action Team, co-ordinating and delivering the government’s national drug strategy.

From 2003 to 2010, Kate was also seconded to the University of Central Lancashire, International School for Communities Rights and Inclusion as Director of Black and Ethnic Minority Community Engagement, focussing on the health and social care of diverse groups who experience discrimination and/or disadvantage and directing the national community engagement programme.

Kate has been a Non-Executive Director on the National Treatment Agency Board in England between 2000 and 2013. She was also a member of the government’s Independent Board for the Prison Drug Treatment Strategy Patel Review, which implemented the substance treatment service and strategy and delivery across England and acted as an Ambassador for Diversity in Public Appointments for the government Public Appointments Commission.

Kate worked in the probation service and was a qualified Probation Officer from 1986 to 1995, before joining the NHS. She was awarded an OBE in 2009, for services for ‘work with disadvantaged people’.

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6 comments

Speaking from the extremely difficult side of a family member of a veteran, and with the first hand information of many other women in the same position, it is very typical, as expressed here, that veterans vehemently deny any problems, whether they are aware they are experiencing them or not. A most common trait in the veteran with mental health issues, is a portrayal of a very good public image and very convincing public persona. This is doubly painful for wives as even their own family members deny them the support as it ‘appears’that they are being neurotic in the absence of evidence. A woman trying to keep a family together will not come forward and destroy her husband’s reputation either, as the stigma between veterans exists, so they suffer in silence. I cannot express strongly enough how bad the emotional and mental abuse these women are suffering is, it is immense. It is not recorded as only a minority of men admit to needing help and even then, the impact on their wives or children is not being addressed. While I appreciate that steps to help are intended by having meetings with professionals, may I suggest the only way to gather a true understanding of the problem, is to speak to those in the front line of experience, the partners of veterans, and they too are the ones who should be trained to deal with and help these men who will not seek out professionals as long as ptsd is deemed to be a stigma or label to them, by other veterans and themselves. I am extremely keen to be a facilitator of this. I also wonder why a military service that spends months training an adolescent to behave in a non civilian thought pattern, ie kill on demand ultimately, does not realise it is vital to ‘untrain’ men for normal civilian life, where the opposite thought patterns are needed never mind practical issues like financial responsibility etc. Surely this is fundamental to survival and resultant good mental health. In short, if you take lambs, train them to be wolves and then release them back into the fold,as the services does, it’s a no brainer there will be problems. The financial cost of this before leaving the services would be far less than the price which is currently not being taken account of because it is still hidden.

Hi Kate,
Just read your article and statement, very positive.
In Doncaster our veteran mental health provision is very effective and veterans are prioritized and offered an immediate assessment, provided by our RDaSH partners. Unfortunately, 5 years on from the Covenant launch and respective 2013 NHS veteran specific legislation identifying responsibility for Veteran primary care, we do not yet have effective engagement with our local NHS CCG/43 GP Surgeries. I would be grateful if you would call me or provide your contact details to discuss this further. Kind regards, Mark

Hi Kate
Just a reminder that in the North West of England the CCGs came together in 2013 to collaboratively commission specialist NHS mental health services for veterans and, after a competitive procurement process, have now got contracts in place for a service until July 2018.

I am pleased that there is now clear acceptance that most veterans are fine. I am a veteran who has been to war so these issues are of real interest to me. At the same time, I’ve been immersed in the frontline world of veterans in crisis for many, many years. Consequently, I feel duty bound to say, whether its inconvenient or not, that it is rare for us to see any client with service related issues regardless of what many “experts”, media pundits and charities claim. We have had an addiction service for many years and I am far from convinced that the source of our clients’ addiction problems are service related…poverty and cheap alcohol play a significant part! But for many the real fixation has been about PTSD to the exclusion of much else. I was delighted to see our significant experience echoed recently by Forces in Mind:

“Post-Traumatic Stress Disorder (PTSD) is the mental health illness most people associate with military service. During the course of the war in Afghanistan it grabbed many headlines. But the reality is PTSD is only a problem for a minority of veterans. Air Vice Marshal Ray Lock from the Forces In Mind Trust said:
“… study after study has shown that it’s no greater, no more prevalent, in the Armed Forces community than it is in the general population

As a veteran who has headed up military mental health services, has held appointments as an NHS mental health trust executive director and as a chief executive of a veterans’ mental health charity, I fully concur with Hugh Milroy’s comments.

In 2003 I retired from my post as Medical Director of Norfolk Mental Health Services and Consultant Psychotherapist.
At that time and since then the NHS waiting list for psychological services varied between 18 months and two years. We had no mental health staff apart from a few of us who had undertaken private training who had any chance of being helpful with up to date methods for helping Veterans.
In crisis many of them take to the streets and become addicted to drugs and drink adding to normalisation problems.Central Policies are good. Local resources poor.